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General NPI Number Information
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NPI Number | 1568068609
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Entity Type | Organization
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Legal Business Name | CERTIFIED LAB SERVICES
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Dates
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Enumeration Date | 12/04/2020
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Last Update Date | 12/04/2024
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Provider Practice Location Address
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Address Line | 3123 FAIRVIEW AVE E STE 200
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City | SEATTLE
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State | WA
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Zip | 98102-3051
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Country | US
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Telephone | 480-685-7530
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Fax | 480-900-8853
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Provider Business Mailing Address
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Address Line | 3123 FAIRVIEW AVE E STE 200
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City | SEATTLE
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State | WA
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Zip | 98102-3051
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Country | US
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Telephone | 480-685-7530
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Fax | 480-900-8853
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Authorized Official
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Title or Position | OWNER/ OPERATOR
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Name | JENNIFER A WALLACE
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Credential | MEDICAL ASSISTANT
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Telephone | 480-685-7530
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251K00000X
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Taxonomy Name | Public Health or Welfare Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QC1500X
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Taxonomy Name | Community Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 305S00000X
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Taxonomy Name | Point of Service
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number |
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License Number State |
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Taxonomy #8
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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